Somayeh Haji Ahmadi, Shokouh Sadeghi Zadeh, Morteza Shahbandari, Mohammadreza Elhaie
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引用次数: 0
Abstract
Background: Preoperative Doppler ultrasound (DUS) is routinely used to map upper-limb vessels before arteriovenous fistula (AVF) creation, yet the predictive value of individual morphologic and hemodynamic parameters remains inconsistent. This study evaluated whether preoperative vessel diameters and flow velocities predict functional AVF maturation in end-stage renal disease (ESRD).
Methods: In a prospective cohort (January 2023-June 2025), adults with ESRD undergoing first-time upper-limb AVF creation received standardized DUS within 2 weeks preoperatively. Arterial and venous internal diameters and peak systolic velocities were measured at planned access sites; measurements were obtained in triplicate and averaged. Functional maturation was defined as sustained two-needle cannulation for hemodialysis at ≥300 mL/min for ≥3 consecutive sessions within 6 months, without endovascular or surgical intervention.
Results: Ninety patients were enrolled; one patient was lost to follow-up before the primary outcome assessment, leaving 89 patients for analysis. Radiocephalic (Type 1) AVFs accounted for 32/90 (35.6%) and brachiocephalic (Type 2) AVFs for 58/90 (64.4%). Overall, 66/89 (74.2%) fistulas matured and 23/89 (25.8%) failed (12 early, 11 late). Maturation was not associated with fistula type, diabetes, or hypertension. Our study suggests that Larger distal radial artery diameter was paradoxically associated with failure (2.27±0.54 mm vs 1.98±0.52 mm; p=0.037) and remained significant after multivariable adjustment (coefficient=-1.892; p=0.006). No other assessed arterial or venous diameter or peak systolic velocity predicted outcome.
Conclusion: Most preoperative DUS measurements did not predict AVF maturation; however, larger distal radial artery diameter paradoxically correlated with failure. Larger multicenter studies incorporating arterial wall pathology, venous outflow resistance, and detailed hemodynamics are warranted to refine preoperative decision-making. Arterial quality may be as important as size alone.
背景：术前多普勒超声（DUS）通常用于在动静脉瘘（AVF）形成前绘制上肢血管，但个体形态学和血流动力学参数的预测价值仍不一致。本研究评估了终末期肾病（ESRD）患者术前血管直径和血流速度是否能预测功能性AVF成熟。方法：在一项前瞻性队列研究中（2023年1月- 2025年6月），首次上肢AVF形成的ESRD成人患者术前2周内接受标准化DUS。在计划的通路位置测量动脉和静脉内径和峰值收缩速度；测量结果一式三份，取平均值。功能成熟定义为在6个月内持续两针穿刺血液透析≥300 mL/min，连续≥3次，无血管内或手术干预。结果：90例患者入组；1例患者在主要结果评估前失去随访，留下89例患者进行分析。放射性头（1型）型avf占32/90(35.6%)，头臂（2型）型avf占58/90（64.4%）。总的来说，66/89（74.2%）的瘘管成熟，23/89（25.8%）的瘘管失败（早期12例，晚期11例）。成熟与瘘管类型、糖尿病或高血压无关。我们的研究表明，桡动脉远端直径较大与失败相关（2.27±0.54 mm vs 1.98±0.52 mm; p=0.037），并且在多变量调整后仍然显著（系数=-1.892;p=0.006）。没有其他评估动脉或静脉直径或峰值收缩速度预测结果。结论：大多数术前DUS测量不能预测AVF成熟；然而，较大的桡动脉远端直径与失败矛盾相关。更大的多中心研究包括动脉壁病理、静脉流出阻力和详细的血流动力学，以完善术前决策。动脉质量可能和大小本身一样重要。
期刊介绍：
International Journal of Nephrology and Renovascular Disease is an international, peer-reviewed, open-access journal focusing on the pathophysiology of the kidney and vascular supply. Epidemiology, screening, diagnosis, and treatment interventions are covered as well as basic science, biochemical and immunological studies. In particular, emphasis will be given to: -Chronic kidney disease- Complications of renovascular disease- Imaging techniques- Renal hypertension- Renal cancer- Treatment including pharmacological and transplantation- Dialysis and treatment of complications of dialysis and renal disease- Quality of Life- Patient satisfaction and preference- Health economic evaluations. The journal welcomes submitted papers covering original research, basic science, clinical studies, reviews & evaluations, guidelines, expert opinion and commentary, case reports and extended reports. The main focus of the journal will be to publish research and clinical results in humans but preclinical, animal and in vitro studies will be published where they shed light on disease processes and potential new therapies and interventions.
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